New Study Classifies Orthorexia as Eating Disorder, Not as Obsessive-Compulsive Disorder
Wed, April 21, 2021

New Study Classifies Orthorexia as Eating Disorder, Not as Obsessive-Compulsive Disorder


A new study suggested an eating habit that can mask an eating disorder. Due to an obsession with healthy foods, the person would narrow their food choices to the ones perceived as healthy or pure.

The classification of orthorexia nervosa was investigated by Dalhousie University and St. Thomas More College. Researchers highlighted that orthorexic tendencies could rank weight loss higher than health in food choices. Unlike anorexia and bulimia, orthorexia could easily conceal an eating disorder because the person appears to be eating healthy food. But a closer look would show that they have limited food groups. They published their findings in the journal Eating Behaviors.

What is Orthorexia Nervosa?

In psychiatry, an eating disorder is a mental disorder characterized by abnormal eating habits, which negatively affects a person's mental and physical wellbeing. Anorexia nervosa and bulimia nervosa are the two most common forms of eating disorder. Anorexia refers to restricted food intake due to the fear of gaining weight. People with anorexia often see themselves overweight, despite being physically thin. Bulimia, on the other hand, refers to binge eating followed by purging to quickly get rid of the food. People with bulimia are often motivated by ideal body shape portrayed in media.

According to the National Eating Disorder Association, an American nonprofit association, orthorexia bulimia is a form of eating disorder difficult to detect, compared to anorexia and bulimia. Unlike the other two, people with orthorexia can fool others because their food choices seem healthy. They often check the ingredient lists and nutritional labels, cut down foods high in sugar, fats, and carbs, and follow blogs linked to a healthy lifestyle.



But behind the disguise, orthorexia can cause high stress if the person cannot find healthy foods, as opposed to an average person. The disorder also prevents them from anything outside their preferred food groups. In an event their preferred food groups are not present; it can cause tremendous mental stress on their part. Unfortunately, research is yet to classify orthorexia as an independent condition, rather than associated with obsessive-compulsive disorder (OCD).

Since it is not an official standalone disorder, there is no accurate population of people with orthorexia. Though, previous studies found symptoms of OCD in many cases of orthorexia. As of the moment, there is no exact treatment for the condition. Psychiatrists may apply psychotherapy to widen food choices and alleviate fear from eating disliked food groups.



New Study Classifies Orthorexia Nervosa

Recently, a team of researchers investigated the true classification of orthorexia. Their investigation could help formalize the disorder and define specific treatments. They proposed orthorexic tendencies prioritize weight loss over health in food selection. The prioritization closely resembled one of the core signs in anorexia and bulimia.

Dr. Renee Engeln, a professor of psychology at Northwestern University, explained the confusion in orthorexia in the US magazine Psychology Today. Anorexia is centered around body image, causing the person to fear gaining weight. To diagnose anorexia, an expert must determine the significant low body weight of the person. But to diagnose orthorexia, an expert must determine something certain to rule out other eating disorders. Experts argue because the symptoms shadow OCD, in which the person is obsessed with food groups.

To shed some light, researchers recruited more than 500 participants and instructed them to complete a survey. The survey measured symptoms of OCD, orthorexia, eating disorders, and motives for food choice. The measures for orthorexia included an inquiry whether or not healthy food interfered with other aspects of their lives. It also inquired whether they felt very anxious or guilty after eating food they perceived as unhealthy. And finally, it queried if their list of food rules was expanding over time.

Researchers analyzed the responses and found that orthorexia-related signs were associated with OCD symptoms. But the link disappeared when they statistically controlled symptoms of eating disorders. This separated the two disorders and potentially made orthorexia a standalone condition. People with signs of orthorexia might show symptoms of OCD due to the apparent tendencies to be obsessed or compelled.

Based on the analyzed survey, participants with orthorexia tendencies were more likely concerned about weight control than healthy foods. Their tendencies were closer to body image and weight loss, similar to other eating disorders. Researchers concluded that orthorexia nervosa is most likely an eating disorder.

Dr. Engeln explained two things. First, orthorexia might be a sub-threshold eating disorder. Some might start with perceived healthy foods. That perception might shift on weight loss as their eating habit becomes more disordered. But some could recover if their perception is corrected – putting more emphasis on healthy eating.

Second, orthorexia might not be a sub-threshold. It could be a manifestation of an eating disorder. The manifestation introduced a warped view of healthy eating. The warped view concealed the true nature of the problem, which could be signs of anorexia. Either way, orthorexia could lead to severe clinical outcomes if not caught.



Global Eating Disorders Share of Population and Direct Deaths

According to Statista, a German portal for statistics, for four consecutive years, the share of the population of people with eating disorders was 0.21%, from 2014 to 2017. That figure reflected a slight increase from 0.2% from 2009 to 2013. If compared to more previous years, a steady increase in the trend of eating disorders would be observed. From 2003 to 2008, the share of the population of people with eating disorders was 0.19%. And from 1990 to 2002, the share was only 0.18%.

Eating disorders must be taken seriously since sufferers are at risk of untimely death. In 2017, 42 deaths were directly linked to eating disorders in the US. In 2016 and 2015, the respective direct deaths were 41 and 40. In 2014, 41 direct deaths were reported and 39 direct deaths were confirmed in 2013. The trend of direct deaths between 39 and 42 persisted from 2002 to 2017. For 28 years from 1990 to 2017, the lowest direct deaths were reported in 1990 and 1991 at 22 each.

Orthorexia can be difficult to identify. But eating disorders have a clear signal: if eating habits are starting to negatively influence other aspects of life, then the habits are putting the person to the danger zone.